What are intestinal stones. How are enteroliths formed. What causes intestinal obstruction due to enteroliths. How is enterolithiasis diagnosed and treated. What are the risk factors for developing intestinal stones.

What Are Intestinal Stones (Enteroliths)?

Intestinal stones, also known as enteroliths, are solid masses that form within the intestinal tract. They are an uncommon finding and a rare cause of bowel obstruction. Enteroliths can be classified into two main types:

• Primary enteroliths: These form directly within the intestine
• Secondary enteroliths: These originate outside the intestine and migrate into it, with gallstones being the most common type

The prevalence of enterolithiasis ranges from 0.3% to 10% in certain populations. While uncomplicated cases have a low mortality rate, poorly conditioned patients with severe obstruction and delayed diagnosis can have a mortality rate of up to 3%.

How Do Intestinal Stones Form?

The formation of primary enteroliths is primarily caused by enterostasis, which refers to stagnation of intestinal contents. Several factors can contribute to enterostasis:

• Strictures due to conditions like intestinal tuberculosis, Crohn’s disease, or tumors
• Incarcerated hernias
• Intestinal kinking from intra-abdominal adhesions
• Post-surgical enteroanastomoses
• Radiation enteritis
• Blind pouches
• Afferent loops
• Diverticulae

Among these causes, tuberculous strictures are the most common reason for intestinal stone formation. The stagnation of intestinal contents in these areas allows for the precipitation and accumulation of substances that eventually form solid masses.

What Are the Symptoms of Intestinal Obstruction Due to Enteroliths?

Intestinal stones can cause partial or complete bowel obstruction, leading to various symptoms. The case report describes a 21-year-old woman who presented with:

• Gradually progressive colicky pain in the hypogastrium for 6 days
• Vomiting
• Constipation
• Ability to pass flatus but cessation of bowel movements

These symptoms are typical of a partial small bowel obstruction. In more severe cases, patients may experience complete obstruction, leading to inability to pass gas or stool, severe abdominal pain, distension, and potentially life-threatening complications if left untreated.

How Is Enterolithiasis Diagnosed?

Diagnosing enterolithiasis can be challenging due to its rarity. However, several imaging techniques can be used to identify intestinal stones:

Plain Abdominal X-ray

Plain abdominal radiography can detect enteroliths in up to one-third of cases. In the reported case, the X-ray showed multiple radiopaque shadows within the small bowel, without air-fluid levels or dilated loops.

Computed Tomography (CT) Scan

CT scans provide more detailed imaging and can help confirm the diagnosis. In this case, the CT scan revealed:

• Absence of gallstones
• Intraluminal ovoid structures with peripheral calcification and hypointense centers, indicative of enteroliths
• An adnexal mass

CT scans are particularly useful in differentiating primary enteroliths from secondary ones, such as gallstones that have migrated into the intestine.

Other Diagnostic Methods

In some cases, additional diagnostic procedures may be necessary:

• Ultrasonography
• Magnetic Resonance Imaging (MRI)
• Endoscopy

These methods can provide further information about the location, size, and nature of the enteroliths, as well as identify any underlying pathology contributing to their formation.

What Are the Treatment Options for Intestinal Stones?

The treatment of enterolithiasis depends on the severity of the obstruction and the patient’s overall condition. Options include:

Conservative Management

In cases of partial obstruction, initial treatment may involve:

• Nasogastric tube decompression
• Intravenous fluid resuscitation
• Electrolyte correction
• Bowel rest
• Administration of antispasmodics

In the reported case, the patient showed poor response to conservative management after 48 hours, necessitating surgical intervention.

Surgical Intervention

When conservative management fails or in cases of complete obstruction, surgery is often required. The surgical approach may involve:

• Laparotomy for abdominal exploration
• Enterotomy for stone removal
• Manual “milking” of smaller stones into the rectum, if possible
• Resection of strictured segments
• Treatment of underlying pathology (e.g., stricture dilation, fistula repair)

In the case report, laparotomy revealed multiple dense adhesions in the distal small bowel and an anastomotic ileorectal stricture. The size of the enteroliths (averaging 1 cm) prevented manual “milking” into the rectum, necessitating surgical removal.

What Are the Risk Factors for Developing Intestinal Stones?

Several factors can increase the risk of developing enteroliths:

• History of gastrointestinal surgery (e.g., total colectomy in the reported case)
• Chronic inflammatory bowel diseases (e.g., Crohn’s disease, ulcerative colitis)
• Intestinal tuberculosis
• Intestinal strictures or adhesions
• Diverticular disease
• Intestinal stasis due to motility disorders
• Certain medications that affect gut motility
• Dehydration
• Malnutrition

In the case report, the patient had a history of ulcerative colitis and had undergone a total colectomy with ileorectal anastomosis, which likely contributed to the formation of enteroliths.

Can Intestinal Stones Be Prevented?

While it may not always be possible to prevent enteroliths, certain measures can help reduce the risk:

• Proper management of underlying gastrointestinal conditions
• Regular follow-up after intestinal surgery
• Maintaining adequate hydration
• Ensuring a balanced diet rich in fiber
• Addressing any chronic constipation issues
• Early treatment of intestinal infections or inflammation

For patients with a history of enterolithiasis or those at high risk, regular monitoring and imaging studies may be recommended to detect stone formation early and prevent complications.

What Are the Potential Complications of Untreated Intestinal Stones?

If left untreated, intestinal stones can lead to several serious complications:

• Complete bowel obstruction
• Intestinal perforation
• Peritonitis
• Sepsis
• Malnutrition due to chronic partial obstruction
• Electrolyte imbalances
• Dehydration

These complications can be life-threatening and emphasize the importance of prompt diagnosis and treatment of enterolithiasis.

How Common Are Recurrences of Intestinal Stones?

The recurrence rate of intestinal stones is not well-documented due to the rarity of the condition. However, several factors may influence the likelihood of recurrence:

• Persistence of underlying conditions (e.g., strictures, motility disorders)
• Incomplete removal of stones during initial treatment
• Formation of new adhesions or strictures following surgery
• Ongoing issues with intestinal stasis

To minimize the risk of recurrence, it’s crucial to address any underlying pathology and maintain regular follow-up care. Patients should be educated about the signs and symptoms of recurrence and the importance of seeking prompt medical attention if these occur.

What Role Does Diet Play in the Management of Enterolithiasis?

While diet alone may not prevent or treat intestinal stones, it can play a supportive role in management:

• Adequate hydration to prevent constipation and promote intestinal motility
• High-fiber diet to support regular bowel movements
• Balanced nutrition to prevent malnutrition, which can exacerbate intestinal problems
• Avoiding foods that may exacerbate underlying conditions (e.g., trigger foods in inflammatory bowel disease)

In some cases, dietary modifications may be recommended based on the composition of the enteroliths. For instance, if the stones are primarily composed of calcium, a low-calcium diet might be suggested, although this should be done under medical supervision to avoid nutritional deficiencies.

Are There Any Emerging Treatments for Intestinal Stones?

While surgical intervention remains the primary treatment for symptomatic enteroliths, research is ongoing into less invasive management options:

• Endoscopic removal: For stones located in accessible parts of the intestine
• Lithotripsy: Using shock waves to break down stones, similar to treatment for kidney stones
• Pharmacological dissolution: Using medications to dissolve certain types of stones
• Probiotics: To improve gut motility and prevent stone formation

These approaches are still in various stages of research and are not yet widely available or applicable to all cases of enterolithiasis. However, they represent promising avenues for future treatment options that may reduce the need for invasive surgery in some patients.

In conclusion, intestinal stones or enteroliths are a rare but potentially serious cause of bowel obstruction. Their formation is often associated with underlying gastrointestinal conditions or previous abdominal surgeries. Prompt diagnosis through imaging studies and appropriate treatment, whether conservative or surgical, is crucial to prevent complications. While prevention may not always be possible, managing risk factors and maintaining good gastrointestinal health can help reduce the likelihood of enterolith formation. As research continues, new treatment modalities may emerge, offering less invasive options for managing this uncommon condition.

Intestinal stones: A rare cause of bowel obstruction

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SAGE Open Med Case Rep. 2019; 7: 2050313X19849837.

Published online 2019 May 14. doi: 10.1177/2050313X19849837

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Enterolithiasis or intestinal stones are uncommonly reported. Enterostasis is the
cause of stone formation mainly secondary to tuberculous strictures. Although it
is unusual, enteroliths can cause intestinal obstruction. We report a case of a
mechanical partial intestinal obstruction in a patient with ulcerative colitis
previously treated with total colectomy, with the rare diagnosis of multiple
primary enterolithiasis.

Keywords: Intestinal stones, enterolithiasis, small bowel obstruction, mechanical intestinal obstruction, stricture, ulcerative colitis

Enterolithiasis is a rare cause of small bowel obstruction (SBO). It is classified
into primary and secondary types, with primary enteroliths being formed within the
bowel and secondary ones originating from outside the bowel.¹ Enterostasis, either due to stricture formation (intestinal tuberculosis,
Crohn’s disease (CD), intestinal tumors, incarcerated hernias, intestinal kinking
from intra-abdominal adhesions, post-traumatic or surgical enteroanastomoses,
radiation enteritis, etc. ), blind pouches, afferent loops, or diverticulae, is the
root cause of primary enterolith formation.^1,2 Secondary-type enteroliths are
formed in the organs outside of the gastrointestinal tract and then migrate into the
bowel, with the most common type being gallstones.³ Tuberculous stricture is the most common cause of intestinal stones.⁴ In selected populations, the prevalence of enterolithiasis ranges from 0.3%
to 10%.¹ The death rate of uncomplicated primary enterolithiasis is very low; however,
mortality ascends to 3% in poorly conditioned patients with substantial obstruction
and a late diagnosis.⁵ Enteroliths can be detected in up to a third of the cases with plain
abdominal radiography.¹ Primary enteroliths remain an uncommon medical phenomenon, with isolated case
series or reports in the setting of mechanical SBO. Here, we present a case of a
partial SBO caused by multiple primary enteroliths.

A 21-year-old woman was admitted for gradually progressive colicky pain over the
hypogastrium for 6 days, associated with vomiting and constipation. She was able to
pass flatus, but with cessation of bowel movements. She was diagnosed to have
ulcerative colitis (UC) in the past for which total colectomy was performed,
followed by a manual side-to-end ileorectal anastomosis. She had previous episodes
of partial SBO that resolved with antispasmodics and had an untreated
menometrorrhagia for the past year.

She was hemodynamically stable and her abdomen was not distended. Multiple scars from
previous abdominal surgery were visible. There was tenderness in all four quadrants,
but no signs of peritonism. No anterior wall defects were palpated. Bowel sounds
were hyperactive. Parents rejected vaginal and rectal examination.

Plain abdominal X-ray showed multiple radiopaque shadows within the small bowel, no
air–fluid levels or dilated loops. We further proceeded with plain computed
tomography scan to reach to a final diagnosis of multiple enterolithiasis in the
small bowel ().

Open in a separate window

Plain abdominal X-ray film showing multiple radiopaque shadows within the
small bowel (left). Axial CT (top right) showing absence of gallstones
(white arrow). Axial CT (bottom right) showing intraluminal ovoid structures
with peripheral calcification and a hypointense center (white arrow) and
(bottom left) adnexal mass (black arrow).

Laparotomy was done after 48 h of poor response to conservative management. Abdominal
exploration revealed multiple dense and cohesive adhesions predominantly in the
distal small bowel. An anastomotic ileorectal stricture was found, along with
multiple stones. The size of the enteroliths averaging 1 cm did not allow manual
“milking” of the stones into the rectum (). In the pelvic cavity, a cystic
mass in the left ovary was found. No communicating fistula was identified between
gallbladder and duodenum. Next, left salpingo-oophorectomy was performed, stricture
was excised, stones were removed, and intestinal continuity restored with manual
end-to-end ileorectal anastomosis at a distance of 12 cm from the anal verge. This
was followed by dilation and curettage (D&C).

Open in a separate window

(a) Ovarian cyst alongside multiple enteroliths with an average diameter of
1 cm after surgical removal. (b) Intact left corpus luteal cyst. (c) Ovarian
cyst alongside multiple enteroliths with an average diameter of 1 cm after
surgical removal. (d) Dissected enterolith with exposed core showing
white-colored aggregates.

In the post-operative period, marked malnutrition was detected with a decrease in
serum albumin; for this reason, total parenteral nutrition (TPN) was initiated;
5 days after ex-lap, she presented abundant discharge of succus through the wound.
Urgent relaparotomy was performed. Anastomotic leak was found and was managed by
dismantling of the anastomosis with closure of the rectal stump and end-ileostomy.
Analysis of the biochemical composition of the intestinal stones showed the presence
of calcium dihydrate oxalate (85%), calcium monohydrate oxalate (10%), and carbonate
apatite (5%). The patient made good recovery and continued well upon discharge.

A personalized approach is necessary in the management of enterolithiasis. Timely
assessment of underlying pathology is key in establishing effective treatment to
avoid stone recurrence.¹ In the context of instestinal obstruction, conservative management may be
selectively considered for enteroliths less than 2 cm, in the absence of
intraluminal compromise.⁶

Successful treatment of intestinal stricturing and stone fragmentation using single-
and double-balloon enteroscopy^7,8 as well as endoscopic
lithotripsy^9,10 have been described; however, conclusive evidence is lacking
regarding minimally invasive approaches in the removal of enteroliths. Thus far,
open surgery remains the mainstay of therapy in the majority of cases.¹

An estimated 30 cases of enterolithiasis in association with CD have been reported.¹¹ Even though few cases of enterolithiasis-related SBO with stricturing CD have
been described,¹² it is accepted that CD is a contributing factor in the development of
intestinal stones. ¹ In regards to UC, only one case series makes reference to UC as an underlying
risk factor.¹³ Scant cases of enterolithiasis in association with stricturing UC are reported,¹⁴ with an isolated case presenting as an SBO.¹⁵ Although both forms of inflammatory bowel disease (IBD) are accompanied with
intestinal fibrosis and scarring, stricturing UC is rare.^5,16 While it is assumed that our
patient developed intestinal stones due to anastomotic stricture, it raises the
question whether stenosing disease of the bowel due to UC plays a casual or
contributing role in the pathogenesis of enterolithiasis.

In the setting of SBO, enterolithiasis is an uncommon medical condition that may fall
out of the surgeon’s etiological scope. This clinical and radiological entity should
be within the diagnostic and therapeutic purview of the general surgeon,
radiologist, and gastroenterologist when assessing patients with SBO. Clinician’s
awareness of enterolithiasis as a cause of SBO may yield timely etiologic
recognition, treatment, and correction of risk factors for the development and
recurrence of stones, thus decreasing morbimortality associated with this
pathology.

The authors would like to thank Franco Xavier Saucedo Rentería, MD, for his
contribution in this research.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the
research, authorship, and/or publication of this article.

Ethical approval: Our institution does not require ethical approval for reporting individual
cases.

Funding: The author(s) received no financial support for the research, authorship, and/or
publication of this article.

Informed consent: Written informed consent was obtained from a legally authorized representative
for anonymized patient information to be published in this article.

ORCID iD: Emilio de León Castorena https://orcid.org/0000-0002-6379-5379

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Articles from SAGE Open Medical Case Reports are provided here courtesy of SAGE Publications

Intestinal stones: A rare cause of bowel obstruction

Case Reports

. 2019 May 14;7:2050313X19849837.

doi: 10.1177/2050313X19849837.

eCollection 2019.

Emilio de León Castorena 
^1
 
2
, Miriam Daniela de León Castorena 
³

Affiliations

Affiliations

• ¹ Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.
• ² Hospital Metropolitano “Dr. Bernardo Sepúlveda,” Secretaría de Salud de N.L., Monterrey, Mexico.
• ³ The University of Texas Rio Grande Valley, Edinburg, TX, USA.

• PMID:

  31205711

• PMCID:

  PMC6537081

• DOI:

  10. 1177/2050313X19849837

Free PMC article

Case Reports

Emilio de León Castorena et al.

SAGE Open Med Case Rep.

2019.

Free PMC article

. 2019 May 14;7:2050313X19849837.

doi: 10.1177/2050313X19849837.

eCollection 2019.

Authors

Emilio de León Castorena 
^1
 
2
, Miriam Daniela de León Castorena 
³

Affiliations

• ¹ Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.
• ² Hospital Metropolitano “Dr. Bernardo Sepúlveda,” Secretaría de Salud de N.L., Monterrey, Mexico.
• ³ The University of Texas Rio Grande Valley, Edinburg, TX, USA.

• PMID:

  31205711

• PMCID:

  PMC6537081

• DOI:

  10.1177/2050313X19849837

Abstract

Enterolithiasis or intestinal stones are uncommonly reported. Enterostasis is the cause of stone formation mainly secondary to tuberculous strictures. Although it is unusual, enteroliths can cause intestinal obstruction. We report a case of a mechanical partial intestinal obstruction in a patient with ulcerative colitis previously treated with total colectomy, with the rare diagnosis of multiple primary enterolithiasis.

Keywords:

Intestinal stones; enterolithiasis; mechanical intestinal obstruction; small bowel obstruction; stricture; ulcerative colitis.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Plain abdominal X-ray film showing…

Figure 1.

Plain abdominal X-ray film showing multiple radiopaque shadows within the small bowel (left).…

Figure 1.

Plain abdominal X-ray film showing multiple radiopaque shadows within the
small bowel (left). Axial CT (top right) showing absence of gallstones
(white arrow). Axial CT (bottom right) showing intraluminal ovoid structures
with peripheral calcification and a hypointense center (white arrow) and
(bottom left) adnexal mass (black arrow).

Figure 2.

(a) Ovarian cyst alongside multiple…

Figure 2.

(a) Ovarian cyst alongside multiple enteroliths with an average diameter of 1 cm…

Figure 2.

(a) Ovarian cyst alongside multiple enteroliths with an average diameter of
1 cm after surgical removal. (b) Intact left corpus luteal cyst. (c) Ovarian
cyst alongside multiple enteroliths with an average diameter of 1 cm after
surgical removal. (d) Dissected enterolith with exposed core showing
white-colored aggregates.

See this image and copyright information in PMC

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References

1. 1. Gurvits GE, Lan G. Enterolithiasis. World J Gastroenterol 2014; 20(47): 17819–17829.

      –

      PMC

      –

      PubMed

2. 1. Kappikeri VS, Kriplani AM. Subacute intestinal obstruction by enterolith: a case study. Springerplus 2016; 5(1): 1464.

      –

      PMC

      –

      PubMed

3. 1. Kia D, Dragstedt LR. , 2nd Enterolithiasis associated with side-to-side intestinal anastomosis. Arch Surg 1967; 95(6): 898–901.

      –

      PubMed

4. 1. Yadav G, Husain S, Shukla R, et al. A rare case of calcified enterolith presenting as subacute intestinal obstruction. Indian J Surg 2015; 77(4): 327–328.

      –

      PMC

      –

      PubMed

5. 1. Steenvoorde P, Schaardenburgh P, Viersma JH. Enterolith ileus as a complication of jejunal diverticulosis: two case reports and a review of the literature. Dig Surg 2003; 20(1): 57–60.

      –

      PubMed

Publication types

Fecal stone – causes, symptoms. possible complications and prevention

Doctors call coprolite or fecal stone a fairly dense formation formed from feces in the area of ​​the large intestine. The reasons for its formation are usually disturbed peristalsis, prolonged, turning into chronic constipation and a number of diseases of the gastrointestinal tract.

Often, the disease does not manifest itself at all, but most often, patients have typical signs of intestinal obstruction: they complain of pain in the abdomen, bouts of nausea and vomiting, constipation, the appearance of streaks of scarlet or dark blood in the stool, note that they have liquid and scanty cal.

Usually, the alleged diagnosis is confirmed by doctors performing sigmoidoscopy, colonoscopy and irrigoscopy. Treatment of the disease is carried out mainly by conservative methods, but in the presence of complications, patients undergo urgent operations.

General information about the disease

As a rule, fecal stones form in patients suffering from chronic diseases associated with damage to the colon. As a result of these disorders, the patient slowly forms dense masses of feces in the lumen of the large intestine, which over time can partially or completely block the intestinal lumen.

Coprolites usually form in the elderly. Large stones are very rare and are found infrequently. The largest coprolite in history was recorded almost two hundred years ago and weighed about two kilograms.

Most often, the described disease is diagnosed in the inhabitants of the Northern Hemisphere of our planet, almost always they are residents of fairly prosperous and developed countries who consume a large amount of fatty foods, which naturally provokes prolonged constipation.

This disease affects both sexes equally. Proctologists are engaged in the treatment of coprolite.

Causes

The process of coprolite formation is associated with causes that are both mechanical and chemical in nature.

Among the factors of mechanical origin, we note atony and hypotension of the colon, they are usually detected in older people. In addition, intestinal motility is adversely affected by Parkinson’s disease and intestinal diverticula. In addition to them, the formation of coprolites is also facilitated by the presence of a number of congenital diseases in the patient, for example, Hirschsprung’s disease. All of the pathologies listed above increase the length of the colon, which leads to a longer movement of feces. Also, mechanical reasons include the presence in the intestine of various foreign bodies, for example, seeds from berries, which can then become the core of the future fecal stone.

Causes of a chemical nature include the state of the alkaline environment of the patient’s intestines, as well as the abundant consumption of fatty foods and foods containing a large amount of calcium. Also, inflammatory processes occurring in the intestines and too abundant absorption of fluid by the walls of the patient’s large intestine may be involved in a change in the nature of feces.

Coprolite cannot form without a nucleus, usually it is some foreign body that has entered the colon or hard feces formed as a result of prolonged constipation. Subsequently, the surrounding fecal masses begin to adjoin the core, while they rapidly lose moisture, which leads to the gradual solidification of the future coprolite. With the active use of fatty foods, the processes of hardening and enlargement of the fecal stone will significantly accelerate, and the inflammatory process taking place in the large intestine will further aggravate the situation.

Pathogenesis

The components of coprolite are substances of organic origin, mineral salts, microorganisms and bile acids. The percentage of these components in different stones can vary significantly. So, experts have repeatedly described coprolites, consisting almost entirely of minerals. At the same time, there are many fecal stones, which contain mainly refractory fat, and it is very poorly digested in the stomach.

According to the nature of their origin, all coprolites are divided into true and false. True include coprolites formed directly in the intestine, and false include formations that have entered the large intestine from the bladder or gallbladder or from the kidneys. At the same time, false coprolites can become nuclei, on the basis of which true fecal stones will then begin to form.

Coprolite normally attaches to the intestinal wall and grows. Gradually, at the site of its fixation, an ulcer or bedsore is formed, which can periodically become inflamed and bleed. Large coprolites are able to partially or completely block the intestinal lumen, which will provoke intestinal obstruction. However, the process of formation of such a stone is quite slow, taking an average of about ten years or a little less.

Symptoms

Small coprolites may not manifest themselves for quite a long time, but may be revealed by chance during X-ray or colonoscopy.

In cases of blockage of the intestinal lumen by a stone, patients complain of constipation and pain in the intestinal region, bloating.

Liquid stool is able to pass by coprolite, which is why most patients have loose stools against the background of long constipation.

Sometimes coprolites damage the walls of the intestines, in which case the pain increases, and traces of blood and mucus are recorded in the stool.

In addition, chronic constipation makes patients irritable, they lose their appetite, which leads to weight loss, patients complain of nausea and vomiting, as well as constant weakness.

Complications

Large coprolite can provoke intestinal obstruction, which is manifested by bloating, severe pain, and sometimes fever. During palpation, tension is recorded in the region of the anterior abdominal wall, patients complain of severe pain. The result of long-term damage to the intestinal walls can be malignant proliferation leading to oncology. In addition, injuries of this kind cause scarring. When coprolite enters the vermiform appendix, its rapid blockage occurs, followed by the development of inflammation, which, without proper treatment, leads to a number of serious consequences, including the development of phlegmonous appendicitis in a patient.

Diagnosis

Sometimes a stone can be detected even by rectal examination, without the use of additional diagnostic tools. In addition, large coprolites are detected during detailed palpation of the abdomen, although they are often mistaken for tumors. The location of the stone can be judged by the reaction of the patient, who experiences pain at the time of palpation of the foreign body.

Often these formations can be detected by sigmoidoscopy, through which doctors can detect a stone located, for example, in the rectum.

Another procedure, barium enema, reveals rather large coprolites in the colon, however, these formations are often confused with polyps and tumors.

X-ray, CT colonography, MRI will fix the formation of both large and small sizes, but only in cases where the contrast agent can penetrate into the space located between the coprolite and the intestinal wall.

The most accurate results can be obtained by colonoscopy, thanks to which the doctor can visually assess the location of the stone, and if this technique does not give the desired result, specialists turn to diagnostic laparoscopy. In addition, patients need to pass a general and biochemical blood test, the results of which allow doctors to make a final diagnosis.

As a rule, coprolites are confused with tumor formations in the colon, and therefore an accurate and correct diagnosis may take some time and require a number of additional studies and analyzes.

Methods of treatment

Typically, the treatment of the disease we describe is carried out through the use of conservative methods, excluding surgical intervention. Sometimes coprolites are removed even during a rectal examination; a siphon enema is a more effective method of getting rid of them. Note that any attempt to get rid of fecal stones with a laxative is not only extremely ineffective, but also harmful.

Doctors rarely resort to surgical methods of treatment, usually operations are performed in cases where coprolite is in the appendix and provokes the onset of an inflammatory process. With the development of such complications, urgent surgery is indispensable. In addition, surgical intervention is carried out in case of serious damage to the intestinal walls by a stone, which is dangerous because of the partial death of tissues in the affected area. Another indication for surgical intervention is intestinal obstruction.

However, even in situations where it was possible to get rid of coprolite in a fairly simple and painless way, the patient’s intestines must be examined in detail, since a malignant formation could begin to form at the site of attachment of the stone to the intestinal wall. For the same reason, patients with a tendency to form fecal stones are strongly advised to undergo regular highly specialized examinations.

Forecasts and preventive measures

With a correct and timely diagnosis, the process of getting rid of coprolite will not take much time and will not bring serious discomfort to the patient. The patient’s condition may worsen if intestinal obstruction occurs, if the intestinal walls are damaged by a stone, and the most dangerous is the ingress of coprolite into the appendix, which, as mentioned above, is fraught with serious complications in the form of an inflammatory process.

To prevent the formation of fecal stones, patients are advised to consume more fiber in the diet and limit the intake of fatty foods. In addition, patients at risk should carefully monitor the stool, if necessary, drink a laxative and periodically visit a proctologist.

Fecal stone – causes, symptoms, diagnosis and treatment

Fecal stone is a dense formation formed in the large intestine from feces in chronic constipation, peristalsis disorders and some chronic diseases of the digestive tract. May be asymptomatic or manifest with signs of intestinal obstruction: abdominal pain, nausea, vomiting, scanty liquid feces, bleeding. It is diagnosed with the help of sigmoidoscopy, X-ray examination of the large intestine (irrigoscopy) and colonoscopy. Treatment is conservative with the use of endoscopic manipulations and siphon enema; with inefficiency and complications, surgical interventions are indicated.

General information

Fecal stones (coprolites, fecal calculi) – a consequence of chronic diseases of the large intestine, in which there is a gradual formation of dense, hard fecal masses in the intestinal lumen, which completely or partially block its lumen. Fecal stones are predominantly found in elderly patients. Large coprolites are detected quite rarely; specialists in the field of modern proctology know only a few dozen cases of such calculi. This situation may be due to the difficulties of diagnosis and the long asymptomatic period of the disease. The largest stone weighing about 2 kg was described in 1830.

Pathology is more common in developed countries of the Northern Hemisphere, where people consume less fiber, eat more fat and are more likely to suffer from constipation. There is no correlation by gender, men and women get sick equally often. Doctors proctologists are engaged in treatment and diagnostics.

Fecal stone

Causes

Causes of the formation of fecal stones can be divided into mechanical and chemical. Mechanical factors include hypotension and atony of the large intestine, which often develop in old age. Diseases such as Parkinson’s disease and parkinsonism syndrome, intestinal diverticula also lead to intestinal motility disorders. Also, the formation of fecal stones is provoked by some congenital pathologies, for example, megacolon, Hirschsprung’s disease, additional intestinal loops. With these diseases, the length of the large intestine increases, which leads to a longer passage of feces through it.

Mechanical causes can also include foreign bodies that enter the intestines – berry bones, hard, indigestible pieces of food, animal bones, etc. They act as the nucleus for the formation of fecal stone.

Among the chemical causes of the formation of fecal stones are too alkaline intestinal environment, eating a large amount of refractory fats and foods high in calcium, changes in the composition of feces due to inflammatory processes, increased absorption of water by the walls of the colon.

A core is needed to form a fecal stone. Foreign bodies of the intestine, poorly digested pieces of food, hard pieces of feces, which appeared as a result of prolonged constipation, often act as it. Fecal masses begin to accumulate around the core, which quickly lose water, salts begin to be deposited in them. As a result, the lump hardens and a fecal stone is formed. The process is accelerated if the patient eats a lot of fatty foods or his absorption of fats is impaired. Inflammatory processes also favor the formation of fecal stones with the release of a large amount of mucus, bleeding.

Pathogenesis

Fecal stone consists of various organic substances, mineral salts (calcium carbonate, magnesium phosphate, magnesium oxalate), bile acids and bacteria. The ratio of these components may be different. Fecal stones have been described that consisted solely of calcium carbonate or magnesium phosphate. Sometimes so-called wax fecal stones are formed, which consist mainly of refractory fats with a small content of mineral salts.

According to their origin, true and false fecal stones are distinguished. True ones are formed directly in the large intestine. False can enter the intestinal lumen from the gallbladder through the duct or through the fistula, from the bladder or renal pelvis through the fistula. False stones can become the nucleus for the formation of a true fecal stone.

In most cases, the fecal stone is fixed to the intestinal wall and constantly increases in size. At the place of fixation, bedsores, ulcers occur, which can bleed or become inflamed. Large stones can partially or completely block the intestinal lumen and cause obstructive intestinal obstruction. Large stones are formed for a long time, sometimes about ten years.

Symptoms of a fecal stone

A small intestinal stone may not manifest itself in any way and is detected incidentally during x-ray or colonoscopy. If the fecal stone partially blocks the lumen of the colon, patients complain of constipation, bloating, and spastic pain. Liquid stools can pass by a fecal stone, so patients periodically develop loose stools against the background of chronic constipation. If a fecal stone damages the intestinal wall, the pain may increase. A large amount of mucus appears in the feces, sometimes streaks of scarlet or dark blood. Due to chronic constipation, patients experience irritability, slight weight loss, loss of appetite, nausea, and general weakness.

Complications

Large fecal stones provoke obstruction, which is manifested by sharp pain and bloating, symptoms of intoxication, and sometimes fever. Palpation reveals significant pain, tension of the anterior wall of the abdomen. Long-term damage to the intestinal walls potentiates malignant proliferation; cancer can develop at the site of contact with a fecal stone. Also, damage to the walls leads to the formation of scars and strictures. If a fecal stone enters the appendix, it very quickly causes its blockage and inflammation. As a result of appendicular stones, phlegmonous appendicitis, gangrene or empyema of the appendix may develop.

Diagnosis

If a fecal stone is located in the rectum or distal sigmoid colon, it can be detected by digital rectal examination. During the examination, the proctologist gropes for a solid, mobile formation, sometimes with a loose surface. Traces of feces may remain on the glove after examination. Large fecal stones can be detected by deep palpation of the abdomen, but they are often confused with tumors. Also, on palpation, pain is determined at the location of the fecal stone or in nearby areas.

Sigmoidoscopy can be used to diagnose stool stones in the lower intestine. The technique allows to identify stones in the rectum and sigmoid colon. When carrying out barium enema, it is possible to detect a volumetric formation in the large intestine, but it is rarely possible to distinguish it from a cancerous tumor or a polyp. An x-ray will show a larger or smaller defect in the colon filling with contrast. It is possible to suspect a fecal stone only when the contrast agent penetrates between it and the intestinal wall.

A more accurate diagnosis is made by colonoscopy. The study allows you to better visualize the formation, if necessary, take a biopsy of the wall adjacent to it. If this technique does not work, resort to diagnostic laparoscopy. General analysis and blood biochemistry are of additional importance. They help to distinguish a fecal stone from other diseases, primarily from malignant tumors. So, with colon cancer, a patient is diagnosed with anemia of a significant degree, an increase in ESR, which rarely happens with a fecal stone.

Differentiate fecal stone, first of all, with tumors of the large intestine. On palpation or on a radiograph, they are very difficult to distinguish, therefore, in order to establish an accurate diagnosis, you have to resort to other methods of examination. It should be noted that cancerous tumors are often accompanied by anemia, a sharp loss of body weight, which rarely happens with a fecal stone. Also, the symptoms characteristic of coprolites resemble signs of diverticulosis, and if there are signs of bleeding, then the fecal stone can be easily confused with hemorrhoids, ulcerative colitis.

Treatment of fecal stones

In most cases, intestinal stones can be treated conservatively. Stones in the distal intestines can be removed already with a digital rectal examination. With inefficiency resort to sigmoidoscopy and colonoscopy. Only after using all these methods, you can proceed to the siphon enema, which should be administered by a proctologist. In no case should you try to eliminate fecal stones with laxatives.

Surgery is needed if the stool has migrated into the appendix and caused inflammation. In this case, the appendix is ​​removed. It is also necessary to operate the patient if damage to the intestinal wall has led to its partial necrosis. Sometimes there is a need for surgical treatment for intestinal obstruction. Even if it was possible to get rid of the stone in a conservative way, the intestinal walls must be carefully examined, if necessary, a biopsy should be taken, since a malignant tumor can develop at the point of contact between the coprolite and the intestine. In the future, the patient should undergo regular examinations.

Prognosis and prevention

If the diagnosis is made correctly, it is not difficult to treat a fecal stone, the prognosis for this pathology is favorable. It worsens if the patient has intestinal obstruction, strictures, or cancer. It is dangerous to get a fecal stone into the appendix, as it can cause blockage and purulent inflammation of the appendix (purulent appendicitis).